Continuous Variables Research Articles

Association of carotid endarterectomy at low-volume centers with higher likelihood of major complications and nonroutine discharge.

Carotid artery stenosis (CAS) is associated with an annual stroke risk of 2%-5%, and revascularization with carotid endarterectomy (CEA) can reduce this risk. While studies have demonstrated that hospital CEA volume is associated with mortality and myocardial infarction, CEA volume cutoffs in studies are relatively arbitrary, and no specific analyses on broad complications and discharge disposition have been performed. In this study, the authors systematically set out to identify a cutoff at which CEA procedural volume was significantly associated with major complications and nonroutine discharge. Asymptomatic and symptomatic CAS patients undergoing CEA were retrospectively identified in the Nationwide Readmissions Database (2010-2018). The association of CEA volume with outcomes was explored as a continuous variable using locally estimated scatterplot smoothing. The identified volume cutoff was used to generate dichotomous volume cohorts, and multivariate analyses of patient and hospital characteristics were conducted to evaluate the association of CEA volume with major complications and discharge disposition. Between 2010 and 2018, 308,933 asymptomatic and 32,877 symptomatic patients underwent CEA. Analysis of CEA volume with outcomes as a continuous variable demonstrated that an increase in volume was associated with a lower risk until a volume of approximately 7 cases per year (20th percentile). A total of 6702 (2.2%) asymptomatic and 1040 (3.2%) symptomatic patients were treated at the bottom 20% of hospital procedure volume. Increased rates of complications were seen at low-volume centers among asymptomatic (3.66% vs 2.77%) and symptomatic (7.4% vs 6.87%) patients. Asymptomatic patients treated at low-volume centers had an increased likelihood of major complications (OR 1.26, 95% CI 1.07-1.49; p = 0.007) and nonroutine discharge (OR 1.36, 95% CI 1.24-1.50; p < 0.0001). Symptomatic patients treated at low-volume centers were also more likely to experience major complications (OR 1.47, 95% CI 1.07-2.02; p = 0.02) and nonroutine discharge (OR 1.26, 95% CI 1.07-1.47; p = 0.005). Mortality rates were similar between low- and high-volume hospitals among asymptomatic (0.36% and 0.32%, respectively) and symptomatic (1.06% and 1.49%, respectively) patients, while volume was not significantly associated with mortality among asymptomatic (OR 1.06, 95% CI 0.67-1.65; p = 0.81) and symptomatic (OR 0.81, 95% CI 0.43-1.54; p = 0.52) patients in multivariate analysis. CEA patients, asymptomatic or symptomatic, are at a higher risk of major complications and nonroutine discharge at low-volume centers. Analysis of CEA as a continuous variable demonstrated a cutoff at 7 cases per year, and further study may identify factors associated with improved outcome at the lowest-volume centers.

Attenuation of ventriculomegaly and iron overload after intraventricular hemorrhage by membrane attack complex inhibition.

The pathophysiology of posthemorrhagic hydrocephalus (PHH) is not well understood, but recent data suggest blood components play a significant role. This study aimed to understand the timing of membrane attack complex (MAC) activation after intraventricular hemorrhage (IVH) and the effect of MAC inhibition on PHH development. This study was composed of four parts. First, 24 young adult male rats underwent stereotactic intraventricular injection of autologous blood or saline and MRI on day 1, 3, or 7 after hemorrhage. Second, 18 rats underwent intraventricular injection of saline, autologous blood with aurin tricarboxylic acid (ATA) in vehicle, or autologous blood with vehicle and underwent serial MRI studies on days 1 and 3 after hemorrhage. Third, 12 rats underwent intraventricular injections as above and MRI 2 hours after hemorrhage. Finally, 24 rats underwent the intraventricular injections as above, as well as serial MRI studies on days 1, 7, 14, and 28 after hemorrhage. The MR images were used to calculate ventricular volume and iron deposition. Open field testing was performed to assess functional outcomes. Outcomes on day 28 were reported as a ratio to the animal's baseline values and normalized via log-transformation. Statistical analysis included the Shapiro-Wilk tests for normality and t-tests and 1-way analysis of variance for 2 and 3 groups of continuous variables, respectively. MAC was found within the hematoma 1 day after hemorrhage and persisted until day 7. Administration of ATA resulted in similar intraventricular hematoma volumes compared to vehicle 2 hours after hemorrhage. At 1 and 3 days after hemorrhage, ATA administration resulted in significantly smaller ventricular volumes and less hemolysis within the hematoma than in the vehicle animals. Administration of ATA also resulted in significantly smaller ventriculomegaly and less iron deposition in the periventricular area than in the vehicle rats 28 days after hemorrhage. Functionally, ATA rats were significantly faster, traveled longer distances, and spent less time resting than vehicle rats at 28 days. MAC was activated early and persisted within the hematoma until day 7 after IVH. MAC inhibition attenuated hemolysis in the clot and ventriculomegaly acutely after IVH. One month after hemorrhage, MAC inhibition attenuated ventriculomegaly and iron accumulation and improved functional outcomes.

Feasibility of Weight-based Tube Voltage and Iodine Delivery Rate for Coronary Artery CT Angiography.

The objective of this study was to evaluate the feasibility of weight-based tube voltage and iodine delivery rate (IDR) for coronary artery CT angiography (CCTA). A total of 193 patients (mean age: 58 ± 12 years) with suspected coronary heart disease indicated for CCTA between May and October 2022 were prospectively enrolled. The subjects were divided into five groups according to body weight: < 60 kg, 60 - 69 kg, 70 - 79 kg, 80 - 89 kg, and ≥ 90 kg. The tube voltage and IDR settings of each group were as follows: 70 kVp/0.8 gI/s, 80 kVp/1.0 gI/s, 80 kVp/1.1 gI/s, 100 kVp/1.5 gI/s, and 100 kVp/1.5 gI/s, respectively. Objective image quality data included the CT value and standard deviation (noise) of the aortic root (AR), the proximal left anterior descending branch (LAD), and the distal right coronary artery (RCA), as well as the signal-to-noise ratio and contrast-to-noise ratio of the LAD and RCA. Subjective image quality assessment was performed based on the 18-segment model. Contrast and radiation doses, as well as effective dose (ED), were recorded. All continuous variables were compared using either the one-way ANOVA or the Kruskal-Wallis rank sum test. No significant differences were observed in all objective and subjective parameters of image quality between the groups (P > 0.05). However, significant differences in contrast and radiation doses were observed (P < 0.05). The contrast doses across the weight groups were 27 mL, 35 mL, 38 mL, 53 mL, and 53 mL, respectively, while the ED were 1.567 (1.30, 2.197) mSv, 1.53 (1.373, 1.78) mSv, 2.113 (1.963, 2.256) mSv, 4.22 (3.771, 4.483) mSv, and 4.786 (4.339, 5.536) mSv, respectively. Weight-based tube voltage and IDR yielded consistently high image quality, and allowed for further reduction in contrast and radiation exposure during CCTA for coronary artery diseases.

Tunable Continuous‐Variable Tripartite Entanglement via Simultaneous and Ordinal Cascaded Nonlinear Processes

AbstractMultipartite quantum entanglement plays a vital role in both fundamental science and quantum applications. The cascaded four‐wave mixing (FWM) process is an effective method to prepare multipartite entanglement, however, the physical nature of entanglement based on different cascading paths, i.e., simultaneous cascaded FWM (SC‐FWM) and ordinal cascaded FWM (OC‐FWM), has not yet been conclusively determined. In this article, tunable continuous‐variable (CV) triple‐mode entanglement is proposed to be generated by using both the SC‐FWM and OC‐FWM schemes. The simulation results reveal that the absorption/dispersion properties of the two nonlinear processes can be efficiently tuned by varying the optical parameters (i.e., the photon detuning and the nonlinear susceptibility), resulting in triple‐mode CV entanglement with tunable properties. Compared with the OC‐FWM scheme, the SC‐FWM scheme has a broader entanglement bandwidth and a higher degree of entanglement, where the tripartite entanglement region is 4.38% larger than that of the OC‐FWM scheme. Furthermore, these results indicate that the SC‐FWM scheme has a more compact and stable mode structure with better entanglement performance. Such tunable optical triple‐mode entanglement may find applications in specific quantum communication protocols and pave the way for implementing and manipulating multichannel quantum networks.

Comparison of Transcatheter Edge-to-Edge Mitral Valve Repair for Primary Mitral Regurgitation Outcomes to Hospital Volumes of Surgical Mitral Valve Repair.

Transcatheter edge-to-edge mitral valve (MV) repair (TEER) is an effective treatment for patients with primary mitral regurgitation at prohibitive risk for surgical MV repair (MVr). High-volume MVr centers and high-volume TEER centers have better outcomes than low-volume centers, respectively. However, whether MVr volume predicts TEER outcomes remains unknown. We hypothesized that high-volume MV surgical centers would have superior risk-adjusted outcomes for TEER than low-volume centers. We combined data from the American College of Cardiology/Society of Thoracic Surgeons Transcatheter Valve Therapy registry and the Society of Thoracic Surgeons adult cardiac surgery database. MVr was defined as leaflet resection or artificial chords with or without annuloplasty and was evaluated as a continuous variable and as predefined categories (<25, 25-49, and ≥50 MV repairs/year). A generalized linear mixed model was used to evaluate risk-adjusted in-hospital/30-day mortality, 30-day heart failure readmission, and TEER success (mitral regurgitation ≤2+ and gradient <5 mm Hg). The study comprised 41 834 patients from 500 sites of which 332 (66.4%) were low, 102 (20.4%) intermediate, and 66 (13.2%) high-volume surgical centers (P<0.001). TEER success was 54.6% and was not statistically significantly different across MV surgical site volumes (P=0.4271). TEER mortality at 30 days was 3.5% with no significant difference across MVr volume on unadjusted (P=0.141) or adjusted (P=0.071) analysis of volume as a continuous variable. One-year mortality was 15.0% and was lower for higher MVr volume centers when adjusted for clinical and demographic variables (P=0.027). Heart failure readmission at 1 year was 9.4% and was statistically significantly lower in high-volume centers on both unadjusted (P=0.017) or adjusted (P=0.015) analysis. TEER can be safely performed in centers with low volumes of MV repair. However, 1-year mortality and heart failure readmission are superior at centers with higher MVr volume.

Output Formation Containment for Multiagent Systems Under Multipoint Multipattern FDI Attacks: A Resilient Impulsive Compensation Control Approach.

The increasing number of devices and frequent interactions of agents from networked multiagent systems (MASs) exacerbate the risks of potential cyber attacks, especially the different point attacks and multiple pattern attacks. This article considers the output formation-containment problem for MASs under multipoint multipattern false data injection (FDI) attacks. The multipoint describes the attacks simultaneously occurring on the sensors, actuators, and communication channels; the multipattern captures that sensor and actuator attack signals are both continuous deterministic variables, and the communication channel attack signals are intermittent random variables, obeying the Bernoulli distribution. For such compromised MASs, a novel hybrid protocol is proposed, which integrates a state observer, an attack estimator, an impulsive interactor and a compensation controller. Thereinto, the state observer and the attack estimator are constructed to recover the unmeasured system states and the unknown FDI attack signals, respectively; the impulsive interactor is designed to guarantee that the neighbor's signals are transmitted only at impulsive instants, and meanwhile the channel attacks are randomly launched; using the recovered signals, the compensation controller is devised to alleviate the effect of attacks. A sufficient condition is identified, under which the output formation containment is achieved with cooperative uniform ultimate boundedness (UUB). Finally, simulation results are carried out to validate the effectiveness and advantages of the proposed approach.

Assessing measurement invariance with moderated nonlinear factor analysis using the R package OpenMx.

Assessing measurement invariance is an important step in establishing a meaningful comparison of measurements of a latent construct across individuals or groups. Most recently, moderated nonlinear factor analysis (MNLFA) has been proposed as a method to assess measurement invariance. In MNLFA models, measurement invariance is examined in a single-group confirmatory factor analysis model by means of parameter moderation. The advantages of MNLFA over other methods is that it (a) accommodates the assessment of measurement invariance across multiple continuous and categorical background variables and (b) accounts for heteroskedasticity by allowing the factor and residual variances to differ as a function of the background variables. In this article, we aim to make MNLFA more accessible to researchers without access to commercial structural equation modeling software by demonstrating how this method can be applied with the open-source R package OpenMx. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Smoking characteristics and years since quitting smoking of US adults diagnosed with lung and bladder cancer: A national health and nutrition examination survey analysis.

Smoking is a recognized risk factor for bladder BC and lung cancer LC. We investigated the enduring risk of BC after smoking cessation using U.S. national survey data. Our analysis focused on comparing characteristics of LC and BC patients, emphasizing smoking status and the latency period from smoking cessation to cancer diagnosis in former smokers. We analyzed data from the National Health and Examination Survey (2003-2016), identifying adults with LC or BC history. Smoking status (never, active, former) and the interval between quitting smoking and cancer diagnosis for former smokers were assessed. We reported descriptive statistics using frequencies and percentages for categorical variables and median with interquartile ranges (IQR) for continuous variables. Among LC patients, 8.9% never smoked, 18.9% active smokers, and 72.2% former smokers. Former smokers had a median interval of 8 years (IQR 2-12) between quitting and LC diagnosis, with 88.3% quitting within 0-19 years before diagnosis. For BC patients, 26.8% never smoked, 22.4% were active smokers, and 50.8% former smokers. Former smokers had a median interval of 21 years (IQR 14-33) between quitting and BC diagnosis, with 49.3% quitting within 0-19 years before diagnosis. BC patients exhibit a prolonged latency period between smoking cessation and cancer diagnosis compared to LC patients. Despite smoking status evaluation in microhematuria, current risk stratification models for urothelial cancer do not incorporate it. Our findings emphasize the significance of long-term post-smoking cessation surveillance and advocate for integrating smoking history into future risk stratification guidelines.

Single Institution Evaluation of Electromagnetic Navigation Bronchoscopy for Diagnosis of Pulmonary Lesions.

Electromagnetic navigation bronchoscopy (ENB) utilizes three-dimensional reconstructions based on computed tomography to guide the biopsy of pulmonary lesions. Various limitations have been described; however, supporting data have been limited by small sample sizes. Cases of ENB for evaluation of a pulmonary lesion at a single institution during a 1-year span were reviewed for demographics, lesion location, procedural details, and final tissue diagnosis. ENB was performed by 3 pulmonologists using the Veran platform with rapid on-site evaluation. T test or Mann-Whitney U test compared continuous variables and χ 2 or Fisher exact test compared categorical variables as appropriate. A patient with a negative or inconclusive biopsy was followed for 1 year postprocedure. A total of 107 pulmonary lesions were evaluated. The population studied had a mean age of 67 and a median pulmonary lesion size of 26.0 mm. For malignant lesions, the pathologic diagnostic yield from ENB was 52.1% (37/71). The diagnostic yield of benign lesions was much lower at 16.7% (6/36). The overall procedural complication rate was 8.4% (9/107). Complications were more likely to occur in patients with malignant lesions. The most common complication was pneumothorax, occurring in 5.6% of all biopsies and 7.0% of patients with malignant lesions. This study demonstrates significant differences in diagnostic accuracy between lesions found to be malignant versus benign. Our observed complication rate was slightly higher than other groups have reported, with a greater frequency occurring in patients with malignant lesions; however, the rate of pneumothorax was still lower than computed tomography-guided transcutaneous biopsies.

Clinical Effectiveness of Continuous Glucose Monitoring in Pregnancies Affected by Type 1 Diabetes.

Background: Continuous glucose monitoring (CGM) improves neonatal outcomes in type 1 diabetes pregnancies; however, its effectiveness has not been assessed in a real-world setting in the United States. Objective: The Triple C Study aimed to examine the clinical effectiveness, assessed through maternal glucose control and gestational health outcomes, of CGM use compared with self-monitoring of blood glucose (SMBG) in pregnancies associated with type 1 diabetes in a real-world setting. Research Design and Methods: We retrospectively identified 160 type 1 diabetes pregnancies at the Barbara Davis Center for Diabetes managed with CGM therapy (n = 109) or SMBG (n = 51) over a 6.5-year period (2014-2020). Obstetric care was provided at multiple practices. CGM use was defined as ≥60% wear in the second and third trimesters of pregnancy. Data were obtained from the electronic medical record system, hospital records, and vital statistics departments (Colorado and Wyoming). We used Student's t-test for continuous variables and chi-square test for categorical variables to compare outcomes between groups. Results: The CGM group had more participants meeting trimester-specific hemoglobin A1C (HbA1c) goals throughout pregnancy and postpartum (P < 0.01 in each time period). The CGM group had fewer participants never meeting HbA1c goals in any trimester than the SMBG group (P < 0.001). There were no significant differences in neonatal outcomes between groups, other than for macrosomia (12.8% CGM vs. 29.4% SMBG, P = 0.01). Infants of CGM users required a neonatal intensive care unit admission less often (52.9% CGM vs. 68.3% SMBG, P = 0.0989). Conclusions: CGM use was associated with improved maternal glucose levels in a diverse real-world cohort.

Abstract 4442: Associations between pre-diagnostic plasma metabolites and biliary tract cancer risk in the prospective UK Biobank cohort

Abstract Background Annually, approximately 200,000 people are diagnosed with biliary tract cancer (BTC). Most present with metastatic disease which encompasses a 5-year survival rate of &amp;lt;5%. Etiology is poorly understood though some studies suggest metabolic dysregulation may contribute to development. Previous evaluations of metabolites and BTC risk have primarily been limited to case-control studies, few metabolites, or post-diagnostic blood samples. Methods We evaluated 248,285 adult participants with metabolite data in the UK Biobank, a prospective cohort study. Participants were excluded (6.2%) primarily due to a baseline history of cancer. To reduce potential influences of reverse causation, those who developed cancer or died within one year after baseline blood collection were also removed. Metabolites were trimmed to two standard deviations, log-transformed (ln[x+0.5]), z-scored, and evenly divided into tertiles. Cox proportional hazards regression was implemented to evaluate associations of BTC risk per 1-standard deviation (SD) and across tertiles with hazard ratios (HR) and 95% confidence intervals (95% CI). Models were adjusted for age, sex, education, income, fasting time, and statin use. A p-value of 0.001 was considered statistically significant after multiple comparison adjustment (0.05 divided by 50, the number of independent tests). Results The analyzed cohort includes 232,781 UKB participants with a median age of 58, a median follow-up time of 11.8 years, and 268 first primary incident BTC cases. Multiple metabolites were significantly associated with BTC risk using continuous variables (per 1-SD increment). High triglyceride to total lipid ratios were associated with higher BTC risk, and the strongest association was for intermediate-density lipoproteins (the HR (95% CI) was 1.33 (1.15-1.54), p=0.0001). On the other hand, high cholesterol to total lipid ratios were associated with lower BTC risk, and the strongest association was for the free cholesterol to total lipids in small very-low-density lipoproteins (VLDL) (0.76 (0.66-0.88), p =0.0002). High glutamine was associated with lower BTC risk (0.68 (0.69-0.89), p =0.0003) as was the phospholipid to total lipid ratio in small VLDL (0.75 (0.65-0.87), p =0.0002). Analysis by tertile identified additional significant associations, including a higher polyunsaturated fatty acid to total fatty acid ratio being associated with lower BTC risk (the HR (95% CI) comparing the highest to lowest tertile, 0.50 (0.35-0.71), p-trend=0.0001). Notably, within polyunsaturated fatty acids, a higher omega-6 to omega-3 ratio trended toward higher risk (1.32 (0.94-1.85), p-trend=0.11). Conclusion These findings indicate circulating metabolites may be biomarkers for BTC and suggest that triglycerides, cholesterols, fatty acids, phospholipids, and glutamine may be involved in BTC etiology. Citation Format: Valerie Gunchick, Guochong Gia, Wei Zheng. Associations between pre-diagnostic plasma metabolites and biliary tract cancer risk in the prospective UK Biobank cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4442.

Abstract 5155: CD8+ T cells and CD4+central memory T cells as biomarkers of perioperative anti-PD-1 therapy in combination with concurrent chemoradiotherapy for locally advanced G/GEJ adenocarcinoma

Abstract Background: Gastric or gastroesophageal junction (G/GEJ) adenocarcinoma is one of the most common lethal malignancies in the world. Near half of the G/GEJ adenocarcinoma are locally advanced at diagnosis and with poor prognosis. Several clinical trials including SHARED (ChiCTR1900024428), which conducted in our center, demonstrated that perioperative anti-PD-1 therapy in combination with concurrent chemoradiotherapy for locally advanced G/GEJ cancers, could raise the pCR rate over 30%. However, the biomarkers for patients with pCR are nor clear. Methods: Baseline tumor biopsies and post-treatment surgical tissues were collected for next-generation sequencing (NGS) and mass cytometry (CyTOF). The overall survival (OS) was measured from the date of surgery to the date of death or the last follow-up visit. Results: 34 patients with locally advanced G/GEJ cancer received anti-PD-1 therapy (Sintilimab) in combination with concurrent chemoradiotherapy in our center. Our results met the pre-specified primary endpoint, with a pCR rate of 38.2% (13/34) and median DFS of 17.0 months. Tumor mutation burden (TMB) analyzed by NGS was higher in the pCR group than those not achieving pCR (non-pCR). Deletion of cytoband 7q35, where TPK1 locates, was significantly enriched in pCR groups. The RNA sequencing data revealed an enrichment of dendritic cells (DC), CD8+ T cells and cytotoxic cell signatures in the pCR group. Conversely, the signature for CD4+ central memory T cells (TCM) was observed to be lower in the pCR group. On the other hand, CyTOF data also demonstrated that the proportion of CD8+ T cells, CD8+ effector memory T cells (TEM) were both higher in pCR group at baseline, while CD4+ TCM was lower. Moreover, the proportion of specific subtype characterized by CD127+CD27+CD45RO+CXCR5-CD4+ TCM was significantly lower in pCR patients and significantly reduced after treatment. As continuous variable, only CD8+ T cells correlated with OS. Conclusions: It seemed that CD8+ T cells and CD4+ TCM cells could be predictive biomarkers of perioperative anti-PD-1 therapy in combination with cCRT for locally advanced G/GEJ. Furthermore, we found a new CD4+ TCM subtype defined with CD127+CD27+CD45RO+CXCR5- could be novel biomarkers. Citation Format: Yue Wang, Yawei Chen, Ju Yang, Xiaoyu Zhou, Yutao Wei, Qin Liu, Yang Yang, Wenxian Guan, Baorui Liu, Jia Wei. CD8+ T cells and CD4+central memory T cells as biomarkers of perioperative anti-PD-1 therapy in combination with concurrent chemoradiotherapy for locally advanced G/GEJ adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5155.

Nurse Interns’ Perception of Clinical Preparation and Readiness for Clinical Internship Experiences

Background. As nursing interns enter challenging clinical settings, evaluating their preparation and readiness is vital for adaptation success. Sufficient real-world experience and patient care are crucial preparation components that enable effective practice and higher competencies. Aim. This study aimed to assess nurse interns’ perception of clinical preparation and readiness for clinical internship experiences. Methods. A self-administered questionnaire was distributed, comprising three sections on demographics, clinical preparation requirements, and the Casey–Fink Readiness for Practice Survey. Descriptive statistics as the mean and standard deviation, numbers and percentages, linear regression model, and Pearson correlation coefficient were used for reporting normal distribution, categorical variables, and relationship between a scalar response and one or more explanatory variables and to calculate statistics between two continuous variables. Results. The participants were 130 nurse interns who were involved in an internship between 2016 and 2020, 50% of the nurse interns. They had a moderate level of clinical preparation, and 28.5% of them exhibited a low level. In addition, 53.8% were found to be moderately ready for practice, while 22.3% had a low level of readiness Conclusion. The observed significant positive correlation between perceived preparation and readiness underscores the pivotal role of clinical preparation in influencing practice readiness. Implications. These findings emphasize the importance of targeted interventions aimed at enhancing clinical preparation to directly bolster overall readiness for professional practice among nurse interns.

Artificial Intelligence Readiness Status of Medical Faculty Students

Objective: This research aims to examine the knowledge level and awareness of Faculty of Medicine students about medical artificial intelligence technologies.&#x0D; Methods: In this study involving students studying at Medical Faculties in Turkey, descriptive questionnaire, and the Medical Artificial Intelligence Readiness Scale for Medical Students (MAIRS-MS) were used. The suitability of continuous variables for normal distribution was tested with the Shapiro-Wilk test. Descriptive statistics for continuous variables are presented as mean and standard deviation or median (Q1-Q3). Descriptive statistics for categorical variables are reported as frequencies and percentages. Homogeneity of variances was evaluated with the Levene test. Mann Whitney U test was used to compare the scale subdimension and total scores according to two independent groups; One-way Analysis of Variance or Kruskal Wallis test was used to compare the scale subdimensions and total scores according to more than two independent groups. Dunn-Bonferroni test was used for multiple comparisons if there was a significant difference between the groups. The relationship between MAIRS-MS subdimensions and MAIRS-MS score was evaluated with the Spearman correlation coefficient. MAIRS-MS reliability was determined by Cronbach alpha value. The value of p

Association between body mass index and age of disease onset with clinical outcomes in paediatric-onset Crohn's Disease (CD): a UK nation-wide analyses using the NIHR-IBD BioResource.

The evidence on the relationship between adiposity and disease outcomes in paediatric Crohn's disease (CD) is limited and lacks consensus. To investigate the relationship between (a) body mass index (BMI) and clinical CD outcomes (hospitalisation, surgery, disease behaviour, biologic use, extra-intestinal manifestations (EIMs)) and (b) the age of CD onset with clinical outcomes. Clinical outcomes were examined in CD patients diagnosed at age <17 years and enroled in the National Institute for Health Research IBD-UK BioResource at a median age of 24 years. All outcomes and BMI were recorded at the time of enrolment. Participants were categorised into normal (<25 kg/m2) and high (≥25 kg/m2) BMI. Age at disease diagnosis was categorised into pre-puberty/early puberty (<11 years), puberty (11-14 years) and post-puberty (15-17 years). Spearman rank correlation was used to test the associations between continuous variables and chi-square test to compare categorical variables. 848 participants with CD were included (51.8% males) and median age at diagnosis was 14 years. Participants with high BMI experienced a greater frequency of EIMs (P = 0.05) than those with low BMI (1 type of EIM: 18.5% vs. 13.2%, respectively; ≥2 types of EIMs: 7.8% vs. 5.6%, respectively). Age at diagnosis and BMI showed weak correlations with corticosteroid use (ρ = 0.08, P = 0.03 and ρ = -0.09, P = 0.01; respectively). An early diagnosis (<11 years) was associated with higher occurrence of stenosing and penetrating disease behaviour (P = 0.01) and hospitalisations (P < 0.001). A higher BMI and an earlier age of disease onset are associated with worse CD clinical presentation.

Association Between the Red Blood Cell Distribution Width and 30-Day Mortality in Intensive Care Patients Undergoing Cardiac Surgery: A Retrospective Observational Study Based on the Medical Information Mart for Intensive Care-IV Database.

Millions of patients undergo cardiac surgery each year. The red blood cell distribution width (RDW) could help predict the prognosis of patients who undergo percutaneous coronary intervention or coronary artery bypass surgery. We investigated whether the RDW has robust predictive value for the 30-day mortality among patients in an intensive care unit (ICU) after undergoing cardiac surgery. Using the Medical Information Mart for Intensive Care-IV Database, we retrieved data for 11,634 patients who underwent cardiac surgery in an ICU. We performed multivariate Cox regression analysis to model the association between the RDW and 30-day mortality and plotted Kaplan-Meier curves. Subgroup analyses were stratified using relevant covariates. Receiver operating characteristic (ROC) curves were used to determine the predictive value of the RDWs. The total 30-day mortality rate was 4.2% (485/11,502). The elevated-RDW group had a higher 30-day mortality rate than the normal-RDW group (P<0.001). The robustness of our data analysis was confirmed by performing subgroup analyses. Each unit increase in the RDW was associated with a 17% increase in 30-day mortality when the RDW was used as a continuous variable (adjusted hazard ratio=1.17, 95% confidence interval, 1.10-1.25). Our ROC results showed the predictive value of the RDW. An elevated RDW was associated with a higher 30-day mortality in patients after undergoing cardiac surgery in an ICU setting. The RDW can serve as an efficient and accessible method for predicting the mortality of patients in ICUs following cardiac surgery.

The clinical relevance of fractional curettage in the diagnostic management of primary endometrial cancer.

Hysteroscopy and fractional curettage are commonly utilized techniques for the diagnosis of postmenopausal abnormal uterine bleeding (AUB) and histopathological verification of primary endometrial cancer (EC). This study delves into the clinical significance of procuring preoperative endocervical tissue in conjunction with corpus fractions through fractional curettage. This retrospective study encompassed a cohort of 84 patients diagnosed with T1-stage endometrial cancer (EC) and 55 patients diagnosed with T2-stage EC, who underwent primary treatment between the years 2011 and 2021 at the University Hospital Frankfurt or Jung-Stilling Hospital Siegen. Among the postoperative T2-stage EC patients, a stratification was performed based on preoperative endocervical curettage (ECC) results obtained through fractional curettage. Categorical and continuous variables were compared utilizing the Pearson-Chi-square test, while for multivariate analyses and regression modeling, the Kaplan-Meier method and Cox regression models were respectively employed. The median age of patients with pT2-stage EC was 64 years (range: 38 to 85). A predominant majority of these patients exhibited the endometrioid subtype of EC (90.9%). Upon conducting comparative analysis between groups, a notably higher frequency of laparotomies was observed (p=0.002) among patients in whom preoperatively detected positive endocervical curettage (ECC) was evident. The detection performance of fractional curettage in identifying positive ECC yielded a sensitivity of 70.9% and a specificity of 73.8%. In multivariate analysis, age at diagnosis (p=0.022), positive ECC observed during fractional curettage (p=0.036), and the FIGO stage (p=0.036) emerged as prognostic determinant for progression-free survival (PFS). Independent prognostic factors for overall survival (OS) were age at diagnosis (p=0.003), positive ECC (p=0.008), histological grading (p=0.016), and the FIGO stage (p=0.022). A significant difference in OS was evident between patients characterized by preoperative negative ECC and those displaying positive ECC (81.8 vs. 59.5 months, p=0.019). The retrospective design of the study, as well as a small number of patients. Preoperative determination of endocervical involvement of primary T2-stage EC could be a prognostic indicator in decision-making to treat EC. The conduct of prospective trials is necessary to definitively establish the routine application and associated benefits of fractional curettage in the context of primary endometrial cancer.

The association between previous use of anti-obesity medication and semaglutide weight loss outcomes.

To compare weight loss outcomes between patients starting semaglutide who had previously been on another anti-obesity medication (AOM) compared to those who were AOM-naïve. We performed a retrospective study in patients with overweight or obesity taking semaglutide for weight loss for a duration of 3 to 12 months. Our primary endpoint was assessment of percentage of total body weight loss (TBWL) in patients who started semaglutide as their first AOM (AOM-naïve) compared to those who started semaglutide and had previously taken another AOM (non-AOM-naïve). The secondary outcome was a comparison of the proportions of patients achieving ≥5%, ≥10%, ≥15% and ≥20% TBWL between the groups. Our endpoints were analysed using independent t-tests and ANOVA/ANCOVA for continuous variables and Pearson's test for categorical variables. This study included 305 patients. Outcomes of semaglutide treatment were superior in AOM-naïve patients (n = 231) compared to non-AOM-naïve patients (n = 74) at 3 (6.3% vs. 3.8%), 6 (10.6% vs. 6.7%), 9 (14.0% vs. 9.1%) and 12 months (14.3% vs. 10.6%; p < 0.0001 at 3, 6 and 9 months, and p = 0.01 at 12 months). A greater proportion of patients in the AOM-naïve group achieved a TBWL ≥ 15% (48% vs 21%; p = 0.02) and ≥20% (27% vs 4% p < 0.01) at 12 months. The use of semaglutide in patients with previous intake of other AOMs was associated with inferior weight loss outcomes in comparison to patients who were AOM-naïve.

Application of restorative neurostimulation for chronic mechanical low back pain in an older population with 2-year follow up

IntroductionData on the Medicare-aged population show that older patients are major consumers of low back pain (LBP) interventions. An effective approach for patients with mechanical LBP that has been refractory...

Post-Operative Complications Among Patients Treated with Cystogastrostomy for Pancreatic Pseudocyst

Background: Pancreatic pseudocysts represent a clinical challenge, often resulting from pancreatitis, trauma, or surgery. Traditional management strategies have ranged from conservative treatments to surgical interventions, with varying degrees of invasiveness and associated complications. The evolution of minimally invasive techniques, such as laparoscopic cystogastrostomy (LCG), has offered new avenues for treatment, albeit with an imperative need for a thorough understanding of their outcomes and efficacy. Objective: This study aimed to evaluate the post-operative complications among patients undergoing LCG for pancreatic pseudocysts, contributing to the body of knowledge on patient outcomes and informing clinical practice. Methods: A descriptive case series was conducted at the Department of General Surgery, Lady Reading Hospital, from April 2023 to October 2023. Seventy patients with pancreatic pseudocysts, confirmed via imaging, were included. Those with previous surgeries for pseudocysts were excluded. All procedures were performed by a single experienced consultant. Post-operative complications were monitored within 24-48 hours, including anastomosis leakage, pneumoperitoneum, bleeding, and perforation. Data were analyzed using SPSS version 25, employing mean and standard deviation for continuous variables, and frequencies and percentages for categorical ones. Chi-square tests were used to explore the association between gender and complications, with significance set at p&lt;0.05. Results: Among the patients, 55.7% were female, and 44.3% were male. Post-operative complications included anastomosis leakage (11.4%), pneumoperitoneum (7.1%), bleeding (18.6%), and perforation (4.3%). No significant association was found between gender and any complication (anastomosis leakage p=0.68, pneumoperitoneum p=0.25, bleeding p=0.63, perforation p=0.42). Conclusion: LCG for pancreatic pseudocysts is associated with a notable incidence of complications, including bleeding as the most common. The lack of significant gender disparity in complication rates underscores the procedure's applicability across a diverse patient demographic. These findings advocate for refined surgical techniques and patient management strategies to minimize post-operative risks, contributing to the advancement of care for individuals with pancreatic pseudocysts.